abuse, human, trafficking, slavery, violence



  1. Belles, Nita


Abstract: Human trafficking is the fastest growing criminal enterprise in the world. Healthcare professionals are uniquely positioned to discover individuals who are trafficked and intervene. This article describes the problem, discusses red flags to watch for, common ailments in victims, screening questions if trafficking is suspected, and proactive steps to take in your workplace to deal with human trafficking.


Article Content

As Mimi1 arrived in the emergency room, blood was trickling down the side of her head, which already ached from the blows she sustained in the attack against her. Blood soaked through what was left of her hair. She had lost a large patch after her assailant had grabbed her by the hair and slammed her face to the ground in the gravel alley, then kicked her multiple times in the stomach. She wished she hadn't taken this violent customer to such a private spot.

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Earlier, she had stumbled to her feet, afraid she was badly hurt. She had struggled to get to the street where her trafficker waited. He was her help for any situation-as well as the one who sold her for sex multiple times every night. He had driven her to the hospital and stayed by her side, as pimps do, to protect their merchandise. As hospital staff asked Mimi questions he answered for her.


Although Mimi's story was relayed by another (Sabella, 2011), it is typical for victims of the sex slave trade (U.S. Department of State, 2011b). Often traffickers identify themselves as a loving family member, boyfriend, or employer who is simply trying to help. Victims also may identify traffickers in these ways. For the trafficker, this is a financial decision. Mimi was a great source of income to her pimp. For those unfamiliar with sex trafficking, most don't realize that girls working the streets keep none of the money they receive for sex. All monies-100% including tips, is given to the pimp. Her pimp considers her his property and source of income.


The well-intentioned nurses, physicians, and other staff who cared for Mimi didn't question why this young girl, wearing excessive makeup, was out so late in scantily clad clothing on a cold night. Additionally, no one seemed to realize the need to separate her from the man who accompanied her. If Mimi had been questioned alone, the truth may have been uncovered. The truth was, her name wasn't Mimi at all, but Elis. She was an 18-year-old victim of sex trafficking. Although many sex trafficking victims are American-born citizens, Elis had been trafficked to the United States from Brazil and was forced into prostitution in Las Vegas by the same man who had brought her to the hospital (Sabella, 2011).


As she lay in the treatment room, Elis' mind may have recalled the promises that lead her to this life. She was enticed to the United States with a promise of a job as a babysitter for a wealthy American family and the chance to go to college. Instead, upon arriving in America she was taken to a brothel. Elis didn't try to escape because her trafficker threatened to harm her family if she did. Unfortunately, no one at the hospital recognized Elis was a trafficking victim. She was released from the hospital to her pimp. Upon her release Elis' pimp took her out and continued selling her for sex. Fortunately for Elis, she survived the attack that night and the hospital staff's lack of awareness concerning her situation (Sabella, 2011).



Unfortunately, many like Elis have left the care of health professionals and never been seen again, presumably killed by a John or their pimp. I believe if the staff who treated Elis that night had known she was a trafficking victim, they would have done everything possible to protect her. Sadly, health workers have not been trained to recognize the red flags that indicate when a patient is a victim of human trafficking.


In the 1980s there was a movement in the United States to recognize domestic violence and find help for victims instead of sending them back to their perpetrators. The abolitionist's movement, which seeks to help victims of human trafficking, is trying to secure the same kind of help for its victims.


Despite our sad history with slavery, until the year 2000, human trafficking was not a crime in the United States. Instead it was prosecuted as other crimes, such as promoting prostitution and indentured servitude. In 2000, the United States put into place a law called the Trafficking Victims Protection Act (TVPA) (U.S. Department of State, 2000), making human trafficking a prosecutable offence. Although the TVPA has been revised (U.S. Department of State, 2003, 2006), it continues to need development. However, the law is a good step in the right direction, symbolic of our nation's efforts to stop to this atrocity (Belles, 2011a).


The crime of human trafficking is defined as using force, fraud, or coercion to recruit, harbor, transport, obtain, or employ a person for labor or services in involuntary servitude, peonage, debt bondage, or slavery or a commercial sex act induced by force, fraud, or coercion, or in which person performing the act is under age 18 (U.S. Department of State, 2011c). This means any person under the age of 18 who is involved in any commercial sex act, be it pornography, stripping, or sex exchanged for anything of value, is a victim of what is called "severe human trafficking." Although the word trafficking may imply the movement of a person, physical movement of the victim is not a requisite. People have been born, raised, and trafficked with in the same home. Also note the TVPA protects both U.S. citizens and noncitizens.



Human trafficking is a politically correct term for slavery. There are more slaves today than any time in history. What does modern-day slavery look like in the United States? Slavery looks like the fresh-faced young girl or boy who is being sold for sex by a pimp via the Internet. It looks like the domestic worker living with a family who abuses her physically and sexually and she lives with them in fear for her life. It looks like the factory or migrant worker who lives in a compound with barbed wire designed to keep slaves in, rather than bad guys out.


Although more brutal than ever, modern-day slavery is not as obvious as it was centuries ago. Today race, class, or gender doesn't limit human trafficking. Victims are not just the poor or disenfranchised. They come from every socioeconomic group. American victims are not just foreign-born nationals-the vast majority of sex-trafficked children are American-born citizens (Belles, 2011b).


Most trafficking victims do not realize they are victims. Many are brainwashed and believe they are partnering with or working for their trafficker. Due to brainwashing or fear for themselves or their loved ones, trafficking victims may be reluctant to ask for help.


Human trafficking is rampant throughout the United States. It exists in every state and nearly every city. Look hard enough and you'll find it in our nation's small towns. In short, it's In Our Backyard (Belles, 2011a).



A question I often hear is, "Why are you targeting Christians with this message?" Although the reasons are numerous, a brief explanation follows. Christianity is my faith choice. I feel quite comfortable tapping my Christian brothers and sisters on the shoulders, pointing out reasons we should be a part of this battle as the Christians in the Underground Railroad were in the past (Bordewich, 2006).


The instruction to get involved is clear in Scripture. In John 4, Jesus had a conversation with a loose woman (to the dismay of his disciples), which caused her to change her ways and lead many to Christ. Jesus was not embarrassed or ashamed of her reputation. He was not dissuaded from reaching out to her because it was not culturally acceptable for him, as a man, to have a conversation with a woman, and especially a Samaritan woman. Searching the Bible for situations such as these teaches about the nature of God.


Our minds are finite and we take for granted the linage to which we are born. We don't get to choose our parents or our ancestors. Not so with God. Rahab the prostitute was in the linage of Jesus. God evidently didn't have a problem in associating with those the world called outcasts. Not only was Rahab counted as righteous for her actions (James 2:25), she was chosen by God to be in the lineage of Jesus. God loves, God cares, God honors, and God respects those whom the world labels as low-life.


Jesus was clear about Christian's responsibility to do something regarding issues such as human trafficking when he told the parable of the Good Samaritan. When asked what it takes to inherit eternal life, Jesus immediately replied, we must love God with all our heart and love our neighbor as ourselves. To clarify, he pointed to someone who sacrificially cared for a socially outcast stranger who had been stripped, beaten, and left for dead. Jesus said, "Go and do likewise" (Luke 10:25-37).


In Luke 4:18-19, Jesus describes his mission. It includes evangelism, healing, and proclaiming freedom for prisoners and releasing the oppressed. This certainly describes the problem of human trafficking and slavery:


* There are an estimated 27 million trapped in trafficking today (Bales, Trodd, & Williamson, 2009).


* Human trafficking is the second-largest-and fastest growing-criminal enterprise in the world (Polaris Project, 2011).


* About 80% of all U.S.-trafficked individuals are female, about 50% are children (U.S. Department of State, 2011a).


* In addition to the estimated 100,000 children trafficked annually, 244,000 to 325,000 American children are at risk for sexual exploitation and sex trafficking every year (Estes & Weiner, 2001).



Some say these numbers are conservative. No matter how you view human trafficking, it is a problem that Christians can't afford to ignore.



How might a nurse recognize a human trafficking victim? Nurses and other healthcare professionals are in a prime setting to recognize and intervene on behalf of trafficking victims, and not just in the emergency room. Workers throughout the healthcare system are vital to recognizing trafficking and intervening. However, they must be trained for recognition to take place. The Family Violence Prevention Fund (2005) found that 28% of trafficking victims encountered a healthcare professional during captivity. Tragically, not one of these encounters led to the victim's rescue or identification. The study cited the most likely reason for the lack of help to victims was a lack of knowledge by the provider in recognizing human trafficking victims. Another study of emergency room personnel found only 29% thought trafficking was a problem in their emergency department population. Just 13% felt confident they could identify a patient who was a trafficking victim; less than 3% had training on recognizing trafficking victims (Barrows & Finger, 2008).


Healthcare professionals are uniquely positioned to discover individuals who are trafficked. It is possible one nurse may be the only trusted individual who can connect a victim with desperately needed help. Indeed, the fact that the patient is coming to her or him for medical help exhibits a level of trust. Trust is key to empowering the trafficking victim to reach for freedom. Nurses are especially skilled at building trust. The victim may be fearful of authority or fear that confiding about his or her situation will bring harm personally or to loved ones. If a nurse can begin to understand the perspective of the trafficking victim and communicate that understanding, it may help build trust.


Nurses and other healthcare professionals have been and can continue to be a vital link between recognition and connecting the victim for rescue and restoration. Encountering important red flags such as you sense the person may be giving you false information, should prompt further investigation. Table 1 offers a list of red flags. One trafficking victim probably won't exhibit all these symptoms. The list in Table 2 contains common ailments reported by human trafficking victims.

Table 1 - Click to enlarge in new windowTable 1 Red Flags for Human Trafficking
Table 2 - Click to enlarge in new windowTable 2 Common Ailments Reported in Human Trafficking Victims


Before asking any screening questions, the healthcare professional must be alone with the potential victim. Anyone, including those identifying themselves as family members, must not be in the same room. The nurse can cite confidentiality or hospital policy to create this privacy.


Human trafficking victims will almost never view themselves as "human trafficking victims" and many have never heard the term. They may blame themselves for being in the predicament or feel it is their choice. They may worry they will be jailed for a crime if they confide about what has happened. Even if victims begin talking about the details of their situation, they will only tell part of their story. Be patient; get only enough information to secure appropriate assistance. Asking too many questions or questions at the wrong time may further traumatize or endanger victims.


For both the nurse's and victims' safety, never directly confront the suspected trafficker. Contact law enforcement or hospital security if necessary to put a safe distance between the suspected trafficker and the patient. Leave any confrontation with the potential trafficker up to law enforcement. If a translator is necessary, do not use any person associated with the potential victim. Always call in a translator with no affiliation to the victim. Suggested questions to ascertain if you may be working with a trafficking victim are listed in Table 3. Asking a few of questions should provide enough information to know if one should proceed to the plan of action below.

Table 3 - Click to enlarge in new windowTable 3 Screening Questions for Suspected Human Trafficking Victims


What can a healthcare professional do if they suspect their patient is a victim of human trafficking? If there appear to be no immediate threats, the first suggested step is to consult the National Human Trafficking Hotline at 888-3737-888. The hotline is staffed 24/7, has translators available for any language, and will advise healthcare staff in best practices. They are trained to help healthcare staff connect victims with services and give correct information to law enforcement who may respond.


If the victim is over the age of 18 and chooses to not receive help, his or her choice must be respected. In that case, it is best to let the victim know there is help and if he or she is willing, provide private access to the hotline. Be mindful that giving the victim written information for the hotline or other help may cost the victim serious abuse or even death if his or her trafficker finds such information on the victim. Be very careful not to insist that the information pertaining to human trafficking is taken.


If the victim is under 18, all healthcare professionals are mandatory reporters for child abuse. Call the National Human Trafficking Hotline, 888-3737-888, as well as follow state and institutional protocols for mandatory reporting. Unfortunately, not all U.S. law enforcement or social service workers are trained in understanding and responding to human trafficking situations. Contacting the hotline could help health professionals, law enforcement, and social services take appropriate steps to secure help for the victim and begin a criminal investigation for the perpetrator of the crime.



It is my hope that in the future, that issue of human trafficking will be integrated into the general and continued education of healthcare professionals. Meantime, all healthcare professionals can take proactive steps to help their facility be prepared to help trafficking victims, such as bringing in experts in trafficking for training and making resources readily available to staff. Table 4 outlines additional suggested steps for making your workplace ready to deal with this problem.

Table 4 - Click to enlarge in new windowTable 4 Proactive Steps for Dealing with Human Trafficking

As a Christian nurse you may be the crucial, some would say, handpicked one to make the difference between life and death for a trafficking victim. You may be the person God has sent to answer her prayers. Jesus described the following conversation in heaven, "'For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.' Then the righteous will answer him, 'Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you? When did we see you sick or in prison and go to visit you?' The King will reply, 'I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me,'"(from Matthew 25:35-46, NIV).


Some may look at a young girl in a short skirt who is packing sexually transmitted diseases and an attitude designed to keep anyone she meets at a distance, as a juvenile delinquent. Hopefully, you may recognize her as a possible victim of human trafficking. Healthcare professionals I have trained have told me they remember patients who may have been trafficking victims. Others are soon able to recognize a trafficking situation and able to help.


Elis eventually found a way to escape and today she is recovering and learning skills to build the life she hoped for when she originally came to America (Sabella, 2011). If even one person had helped Elis in the emergency room that night, she would not have spent the following 6 months being sold for sex. You can be that help to someone.


"Whatever you did for the least of one of these, you did for me." As nurses, now that you have begun to recognize a trafficking situation, might you recognize Jesus in a trafficked person's eyes? What a grand opportunity, both for now and eternity.


Web Resources


* National Human Trafficking Hotline-888-3737-888


* Polaris Project-


* Hagar International-


* Campaign to Rescue & Restore Victims of Human Trafficking-



Bales, K., Trodd, Z., & Williamson, A. K. (2004). Modern slavery: The secret world of 27 million people. London, England: Oneworld. [Context Link]


Barrows, J., & Finger, R. (2008). Human trafficking and the health care professional. Southern Medical Journal, 101(5), 521-524. [Context Link]


Belles, N. (2011a). In our backyard: A Christian perspective on human trafficking in the United States. Decorah, IA: Free River. [Context Link]


Belles, N. (2011b, June 29). A Christian call to end human trafficking. The Huffington Post. Retrieved from[Context Link]


Bordewich, F. M. (2006). Bound for Canaan: The epic story of the Underground Railroad, America's first civil rights movement. New York, NY: Harper. [Context Link]


Estes, R. J., & Weiner, N. A. (2001). The commercial sexual exploitation of children in the U.S., Canada and Mexico. Retrieved from


Family Violence Prevention Fund. (2005). Turning pain into power: Trafficking survivors' perspectives on early intervention strategies. Retrieved from[Context Link]


Polaris Project. (2011). Human trafficking. Retrieved from[Context Link]


Sabella, D. (2011). The role of the nurse in combating human trafficking. American Journal of Nursing, 111(2), 28-37. [Context Link]


U. S. Department of State. (2000). Victims of Trafficking and Violence Protection Act of 2000. Retrieved from[Context Link]


U. S. Department of State. (2003). Trafficking Victims Protection Reauthorization Act of 2003. Retrieved from[Context Link]


U. S. Department of State. (2006). Trafficking Victims Protection Reauthorization Act of 2005. Retrieved from[Context Link]


U.S. Department of State. (2011a). Trafficking in Persons Report 2011. Retrieved from[Context Link]


U. S. Department of State. (2011b). Victim's stories. Trafficking in Persons Report 2011. Retrieved from[Context Link]


U. S. Department of State. (2011c). Topics of special interest. Trafficking in Persons Report 2011. Retrieved from[Context Link]


1 This victim's name and other details have been changed to protect her identity. [Context Link]